Provider Demographics
NPI:1639228687
Name:KENNEDY, SARA KATE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:KATE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PINEHURST DR SW
Mailing Address - Street 2:SUITE #103
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4500
Mailing Address - Country:US
Mailing Address - Phone:360-352-8112
Mailing Address - Fax:360-352-8113
Practice Address - Street 1:204 PINEHURST DRIVE SW
Practice Address - Street 2:SUITE #103
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4500
Practice Address - Country:US
Practice Address - Phone:360-352-8112
Practice Address - Fax:360-352-8113
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist